Expert Q & A: How can physical activity be integrated into case management?

An interview with Chris Hill, a personal trainer and case manager, who engages clients through the Active Recovery approach at the Canadian Mental Health Association (CMHA) Cochrane Timiskaming Branch. Active Recovery is not a program, so much as an approach to case management and community support that many staff can be involved in at some level. This approach is used to support clients who show an interest in improving their physical health.

Pictured are Alec Morrison and Chris Gatenby, participants in CMHA Cochrane Timiskaming Branch’s Active Recovery, wrapping up a regular work-out with some cardio and strength training through focus-boxing.

For specialized knowledge in physical activity for clients, CMHA Cochrane Timiskaming has a worker who is trained as a personal trainer (through Can-Fit-Pro) at each of the three branch offices. Chris Hill has 90 clients participating on a weekly basis in activities, including women’s and men’s wellness groups, free golf lessons, tennis, mountain biking, hiking and nature walks, cross-country skiing, snowshoeing, squash, and fishing trips.

Q: How did you become a key staff person in Active Recovery?
I had incorporated physical activity in some of our cognitive-behavioural therapy training before Active Recovery began. So it was a natural fit to start doing more of this.

I was certified as a personal trainer in May 2009 and then began offering every outdoor activity possible. We had bikes donated to the organization for mountain biking.

The gym portion began in September 2009 in partnership with facilities in the City of Timiskaming Shores. The city staff are very supportive of the work we are doing. They can’t believe the change that’s happened with clients in the gym setting.

Q: How does active recovery help clients?
Some people don’t want to interact across the desk…in physical activity they get to work alongside a mental health worker or be a part of a team. It’s easier for them to open up when their heart rate is elevated. Engagement in sports helps clients build bonds and breaks the ice without having to say a word. [It helps people] start to be sociable, build confidence, stabilize moods and reduce manic state severity and depressive lows. We fill their toolbox for coping.

Q: What is an example of the success you’ve seen among the clients?Chris Gatenby has been a client on my caseload for three years to help with depression and anger management. Instead of talking across a desk, it helped to go do something active. Now he assists in Active Recovery, helping with clients in the gym setting. He’s not as concerned with the negative parts of his life; he is thinking of what he is giving back. He wants to get more experience before writing the exam to become a certified personal trainer,

His story is being highlighted in Reader’s Digest as a “hero of mental health.”

Q: How do you involve clients in leadership roles?We have an Active Recovery Committee which meets bi-weekly to allow members to contribute ideas for planning, fundraising and organizing activities. The clients also support each other. To see the peers supporting the other peers – it’s like [the character] Norm walking in on [the television show] Cheers. They don’t need to come to me with a problem, they can go to each other.

Q: How do you determine which clients participate in Active Recovery?
If a client is involved with CMHA, they can ask to be referred to Active Recovery. Another way is through the nurse practitioner who makes some referrals. We are also getting referrals from psychiatrists, psychologists and physicians. Primary care also helps us with taking physical measurements and with any client issues regarding the Physical Activity Readiness Questionnaire.

I do an initial intake [assessment] and then a gym assessment for individualized programming. We ask ‘What would you like to do in the future? What have you enjoyed doing in the past?’ Whatever they want to do, we get them going whether it’s a walking group or sports. The more activity options you give, the more people you are going to reach. We want clients to be able to perform activities on their own and be comfortable in the gym and other environments.

We don’t have a waiting list. I am able to get everyone into something…[although] some may wait for the initial gym assessment. If I do an intake, a client can be active the next day.

Q: How has this new approach changed your workload?
Initially, we were seeing my role as a part-time job, but it is full-time work. The intake assessment, the assessment in the gym, the follow-up on physical measurements…all take time. I’m lucky in the Cochrane Timiskaming branch – there are a lot of staff working with me and who support this approach. I love my job. I’m quite grateful to the agency to be a part of this.

Q: In many of the testimonials, the clients credit you in their recovery process. Do you have advice that could be shared with others in a similar role?
Treat everyone with respect. You’ll get it in return ten-fold. It all has to do with the clients. They’re the actual heroes. They’re the ones taking the chance on me and following through on changes in their life.

To learn more about the Active Recovery approach at CMHA Cochrane Timiskaming Branch, please see the program directory.

Minding Our Bodies is an initiative of the Canadian Mental Health Association, Ontario, in partnership with Mood Disorders Association of Ontario, Nutrition Resource Centre, YMCA Ontario, and York University's Faculty of Health with support from the Ontario Ministry of Health Promotion.